Introduction
Developmental Dysplasia of the Hip (DDH) is a very common condition in newborns. Sometimes referred to as "clicky hips", DDH is an development problem related mostly to the hip socket (acetabulum). Depending on how severe this is, the socket may be more like a saucer than a cup. This can allow the hip to come out of joint. This is not painful, but the socket cannot develop without the ball of the femur being positioned in the centre of the socket.
Treatment
Some cases only need to be monitored with the baby’s hips improving on their own. More severe forms of Developmental Dysplasia of the Hip (DDH) require treatment in the form of bracing to position the hip directly in the centre of the socket. Amazingly, with early treatment the socket can develop fully in around 6-8 weeks. Children diagnosed a little later may require more bracing. In some cases bracing is not enough and surgery is required.
Ultrasound
In babies under 5-6 months the hip is mostly cartilage, and cannot be seen on x-rays. Ultrasound is an excellent tool for assessing the depth of the socket as well as the position and stability of the femoral head. Ultrasound monitoring of improvement in the hip helps determine when any bracing can stop or be weaned down.
Bracing
There are many types of braces. Most newborns go in to a Pavlik harness which gently reduces the hip over time. Other braces include the Rhino brace which is for older children and can be used full or part-time as it is easy to take on and off.
Tips for Hip Positioning
1. AVOID SWADDLING
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Swaddling is a risk factor for developing DDH.
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Your baby should sleep on their back, and a sleep sack is recommended. It is important the sleep sack is properly fitted around the neck and arms, whilst the legs can relax open (abduct).
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If you don’t have a sleep sack, you may choose to “BUNDLE” your baby in a blanket. The blanket should be loose around the hips and legs, allowing movement.
2. BABY CARRIERS
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There are many positive social and health benefits of baby-wearing.
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It is best for the hips to have your baby facing inwards. You should focus on having your baby’s legs apart against your body.
3. HIP STRETCHES
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Hip abduction stretches performed at each nappy change can also be helpful
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It is recommended to spend one minute opening the legs in the “froggy” position with your baby on their back
4. THINGS TO AVOID
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It is preferable to let children engage in activities they have initiated themselves.
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In older infants, jolly jumpers, walkers and any seat that holds the legs firmly together (e.g. bumbos) should be avoided.
